Eligibility + Referral

Accessing Services

For individuals seeking supports and services from Community Mental Health

and Substance Abuse Services of St. Joseph County (CMHSAS-SJC), you can

call our Access Center at (269) 467-1000 and speak with someone about your

needs. All calls are private and confidential.

 

Service Eligibility

The Michigan Department of Health and Human Services (MDHHS) sets

eligibility criteria for CMHSAS services. Services are available to those who:

  • Live in St. Joseph County.
  • Have a serious mental illness, developmental disability, serious emotional

disturbance, substance use disorder and/or co-occurring substance use

disorder.

  • Have Medicaid. If you do not have insurance, we can provide you with a

Medicaid application. If you do not have insurance and meet all other eligibility

criteria, you may be placed on a waiting list.

  • Demonstrate medical need for services.

 

Medical Necessity

Services authorized for treatment of a behavioral health and/or co-occurring

substance use disorder concern must be medically necessary. You will

participate in an assessment of your needs to identify the type of services you

might be eligible to receive. Medical necessity also means that the amount (how

much of a service you get), scope (who provides the service and how), and

duration (how long the service will last) of your services are enough to meet your

needs. Medicaid recipients are guaranteed to receive services that are medically

necessary. For people who have no insurance, there is no guarantee they will get

services if there is not the money to provide those services, and they may be

placed on a waiting list.

If you have Medicaid:

  • You are eligible for a specific set of services based on medical necessity.
  • You cannot be put on a waiting list for a service considered “medically

necessary” unless you are in agreement.

If you do not have Medicaid (General Fund):

  • The list of services is not as large as it is for those who have Medicaid.
  • You can be put on a waiting list for mental health services if there is not

enough funding to provide the service and you do not qualify for Medicaid.

 

Referrals

We accept referrals from a variety of resources including schools, doctor offices,

and mental health professionals. Concerned family or friends may call to inquire

about services, but anyone over the age of 18 who serves as their own guardian

will have to call to make their own referral. Parents or legal guardians can make

referrals for anyone under the age of 18.

 

Payment for Services

If you are enrolled in Medicaid and meet criteria for services, the total cost of

your authorized mental health or substance abuse treatment will be covered (no

fees will be charged to you.)

Otherwise, services are based on eligibility and payment is based on what you can afford.
CMHSAS-SJC will assess a person’s ability to pay for services and establish a fair fee.

To determine your fee, a review of requested documents along with information
you provide will be reviewed. In general, you’ll be asked to provide information
about any sources of income or health insurance that may cover services.
All financial information will be held in the strictest confidence.  Once a fee has
been determined, you also can ask for a review of your determined fee if you do
not agree with the amount you are asked to pay.

Make sure that you inform CMHSAS-SJC of all the insurances you are covered

by, as well as any changes to your insurance. If you fail to provide insurance

information you may be at risk of being charged services that might otherwise be covered.

 

Emergency Services

24hr

A mental health emergency is when a person is experiencing symptoms and

behaviors that can reasonably be expected in the near future to lead them to

harm themselves or others; and/or because of their inability to meet their basic

needs they are at risk of harm; and/or the person’s judgment is so impaired that

they are unable to understand the need for treatment and that their condition is

expected to result in harm to themselves or others in the near future.

You have the right to receive emergency services at any time, 24 hours a day, 7

days a week, without prior authorization for payment of care. If you have a

mental health emergency, you should seek help right away. At any time during

the day or night you can call 1-800-622-3967 and speak to a crisis worker. You

can also call 911 or go to your nearest hospital emergency room.

 

Out of County Emergency Mental Health Care

If you have Medicaid, carry your card with you at all times. You are covered for

emergency mental health services anywhere within the State of Michigan. If you

have a mental health emergency while you are outside of the county where you

receive services, you should contact the CMH office where you are at during the

time of the emergency, or go the nearest hospital emergency room. The CMH

office where you are during the emergency will contact CMHSAS-SJC to arrange

for your care.